|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 37000-019-01
|
| Hospital Charge Code |
NDG112159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 149003930
|
| Hospital Charge Code |
NDG112159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
OP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-30
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
IP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-13
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
OP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-10
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
OP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-01
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
IP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-30
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
IP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-01
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
OP
|
$1.56
|
|
|
Service Code
|
NDC 60687-679-11
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Senior |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
IP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-10
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
OP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-13
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
IP
|
$1.56
|
|
|
Service Code
|
NDC 60687-679-11
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.07
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT J0583
|
| Hospital Charge Code |
1722040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Adventist Health Commercial |
$17.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$73.02
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$39.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$64.42
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$58.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$73.02
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT J0583
|
| Hospital Charge Code |
1722040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Adventist Health Commercial |
$17.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.01
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.15
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$64.42
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$58.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.70
|
|
|
Bladder instillation of anticarcinogenic agent (including retention time)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 51720
|
| Min. Negotiated Rate |
$155.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: Dignity Health Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$853.50
|
| Rate for Payer: Humana Medicare |
$853.50
|
| Rate for Payer: IEHP Medi-Cal |
$155.66
|
| Rate for Payer: IEHP Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,621.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$938.85
|
| Rate for Payer: TriValley Medical Group Senior |
$853.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
Bladder irrigation, simple, lavage and/or instillation
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 51700
|
| Min. Negotiated Rate |
$122.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$122.55
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$308.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
OP
|
$60.55
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$578.72 |
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$37.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.72
|
| Rate for Payer: Blue Shield of California Commercial |
$45.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.12
|
| Rate for Payer: Blue Shield of California EPN |
$45.12
|
| Rate for Payer: Blue Shield of California EPN |
$45.12
|
| Rate for Payer: Blue Shield of California EPN |
$45.12
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.47
|
| Rate for Payer: Dignity Health Senior |
$58.34
|
| Rate for Payer: Dignity Health Senior |
$51.47
|
| Rate for Payer: Dignity Health Senior |
$33.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Heritage Provider Network Senior |
$18.40
|
| Rate for Payer: Heritage Provider Network Senior |
$31.78
|
| Rate for Payer: Heritage Provider Network Senior |
$28.03
|
| Rate for Payer: IEHP Medi-Cal |
$39.75
|
| Rate for Payer: IEHP Medi-Cal |
$39.75
|
| Rate for Payer: IEHP Medi-Cal |
$39.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$45.41
|
| Rate for Payer: Multiplan Commercial |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$51.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
| Rate for Payer: Vantage Medical Group Senior |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$51.47
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
IP
|
$68.64
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$51.48 |
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.60
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.90
|
| Rate for Payer: Heritage Provider Network Senior |
$40.99
|
| Rate for Payer: Heritage Provider Network Senior |
$26.90
|
| Rate for Payer: Heritage Provider Network Senior |
$46.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$45.41
|
| Rate for Payer: Multiplan Commercial |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$51.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.28
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
OP
|
$112.34
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$578.72 |
| Rate for Payer: Adventist Health Commercial |
$22.47
|
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Adventist Health Commercial |
$25.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$108.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$61.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$60.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.72
|
| Rate for Payer: Blue Shield of California Commercial |
$45.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.12
|
| Rate for Payer: Blue Shield of California EPN |
$45.12
|
| Rate for Payer: Blue Shield of California EPN |
$45.12
|
| Rate for Payer: Blue Shield of California EPN |
$45.12
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.22
|
| Rate for Payer: Dignity Health Senior |
$108.22
|
| Rate for Payer: Dignity Health Senior |
$95.49
|
| Rate for Payer: Dignity Health Senior |
$68.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Senior |
$58.95
|
| Rate for Payer: Heritage Provider Network Senior |
$37.05
|
| Rate for Payer: Heritage Provider Network Senior |
$52.01
|
| Rate for Payer: IEHP Medi-Cal |
$39.75
|
| Rate for Payer: IEHP Medi-Cal |
$39.75
|
| Rate for Payer: IEHP Medi-Cal |
$39.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.01
|
| Rate for Payer: Multiplan Commercial |
$95.49
|
| Rate for Payer: Multiplan Commercial |
$84.26
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$108.22
|
| Rate for Payer: Vantage Medical Group Senior |
$95.49
|
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
IP
|
$127.32
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$95.49 |
| Rate for Payer: Adventist Health Commercial |
$25.46
|
| Rate for Payer: Adventist Health Commercial |
$22.47
|
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.18
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.18
|
| Rate for Payer: Heritage Provider Network Senior |
$86.20
|
| Rate for Payer: Heritage Provider Network Senior |
$54.18
|
| Rate for Payer: Heritage Provider Network Senior |
$76.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.01
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Multiplan Commercial |
$95.49
|
| Rate for Payer: Multiplan Commercial |
$84.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.74
|
|
|
Blepharoplasty, lower eyelid;
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15820
|
| Min. Negotiated Rate |
$696.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$696.95
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,278.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Blepharoplasty, upper eyelid;
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15822
|
| Min. Negotiated Rate |
$526.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$526.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,278.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Blepharoplasty, upper eyelid; with excessive skin weighting down lid
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15823
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,278.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Bone graft, any donor area; major or large
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 20902
|
| Min. Negotiated Rate |
$4,857.00 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Bone graft, any donor area; minor or small (eg, dowel or button)
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 20900
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$300.85
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
